Care Management RN Manager (Compact Licensed)

Company Description

Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities.

We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.

Position Responsibilities

Specific

• Design Care Management/ Population Health programs and processes to meet current strategic needs and in anticipation of future state innovation
• Design/ implement overall department structure such that a) staffing is appropriate and cost-effective; b) technology use is maximized; and c) staff and operational performance standards are met or exceeded
• Design, develop and facilitate understanding, adoption and compliance with Model of Care
• Ensure vendors meet obligations and fulfill contractual requirements
  
  

General

• Provide support for health plan market/ product level operational oversight, management and performance improvement
• Leverage industry expertise and knowledge to provide high value consulting and advisory services
• Deliver integrated solutions in support of client goals and engagements.
• Provide delivery assurance support for engagements with assigned clients
• Support engagements ensuring completion of contracted services
• Create and/ or manage to project plans
• Prepare materials for presentation to Client executives
• Facilitate and inform key decisions through the use of data and industry best practice sharing
• Deliver concise, clear interpersonal communication to both internal and external audiences
• Facilitate streamlined exchange of information with engagement manager and client organization partner(s)
• Leverage proven methodologies and best practices in support of individual account strategies/ client plans
• Establish goals and track progress to ensure achievement
• Act in interim leadership capacity to provide supervision and oversight for teams and activities in a direct supervisory model
• Identify opportunities to improve workflow, generate accurate, high-quality productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational quality performance in collaboration with Client leaders
• Develop or update policies and procedures as required to support business needs and requirements
• Identify opportunities to streamline and/ or automate workflows
• Manage and develop staff to reach established engagement goals, deliverables and KPIs
• Adapt processes, approach, plan and/ or activities in real time to ensure critical path activities are achieved
• Support account management relationships with key client decision makers
• Develop and deploy management reporting, if indicated, to support monitoring and improvement of performance, implementing plans for improvement as necessary
• Responsible for ensuring quality, maintaining appropriate resources, competency training and education of staff
• Responsible for approving and managing day to day engagement resourcing/ time and attendance as an Engagement Manager
• Oversee compliance with internal client related audits, support Client preparation for external audits and surveys
  
  

Competencies

Position Qualifications:

• Experience managing complex work in challenging environments through the alignment of resources and prioritization of efforts to ensure on time, in scope project and/ or strategic delivery.
• Managed care industry knowledge in operations, costs, requirements, performance and outcomes
• Product/ market operational experience in Commercial, Medicare, Medicare Advantage, Medicaid or associated lines of business
• Understanding of legal and regulatory frameworks, healthcare administration models, and internal audit procedures.
• Understanding of key regulations, frameworks, accreditation and oversight bodies to ensure compliance with complex regulatory structures.
• Knowledge of project management principles, methods, and techniques
• Ability to organize, and manage multiple competing priorities
• Strong communication skills both written and oral
• High proficiency with core office software (Excel, Word, and PowerPoint). Visio skills preferred
  
  

Experience

• LTSS experience required
• Bachelors Degree in Nursing or other affiliated health care discipline required, Master’s Preferred
• Registered nurse with current unencumbered compact license
• Experience in clinical leadership in a Managed Care environment
• Experience working with vulnerable populations helpful, knowledge of health disparities highly desired
• Experience managing an interdisciplinary care team in a fast paced, time-sensitive environment
• 2+ years progressive experience in managed care at the Manager level or equivalent level, preferably in a government payor environment
  
  

Physical Requirements

• Must be able to sit in a chair for extended periods of time
• Must be able to speak so that you are able to accurately express ideas by means of the spoken word
• Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices
• Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse
• Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types
• Must be able to fluently communicate both verbally and in writing using the English language
• Must be able to engage in continuous social interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously
  
  

Time Zone: Eastern or Central

Other Information

• Expected Hours of Work: Friday 8am – 5 pm; with ability to adjust to Client schedules as needed
• Travel: May be required, as needed by Client
• Direct Reports: None
• Salary Range: $100,000 - $150,000
  
  

EEO Statement

It is Clearlink Partners’ policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum target wage for new hires of this position across all US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location.